CLINICAL RESEARCH: CARDIAC IMAGING
Mortality Incidence and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Angiography
Matthew P. Ostrom, MD,
Ambarish Gopal, MD,
Naser Ahmadi, MD,
Khurram Nasir, MD, MPH,
Eric Yang, MD,
Ioannis Kakadiaris, PhD,
Ferdinand Flores, BS,
Song S. Mao, MD and
Matthew J. Budoff, MD*
Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
Manuscript received March 3, 2008;
revised manuscript received July 11, 2008,
accepted July 14, 2008.
* Reprint requests and correspondence: Dr. Matthew J. Budoff, Harbor-UCLA Medical Center, 1124 W. Carson Street, RB2, Torrance, California 90502 (Email: mbudoff{at}labiomed.org).
Objectives: This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients.
Background: Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies.
Methods: In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 ± 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD ( 50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC).
Results: During a mean follow-up of 78 ± 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD.
Conclusions: The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.
Key Words: outcomes CT angiography cardiac CT prognosis coronary calcium
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Abbreviations and Acronyms
| | AUC = area under the curve | | CAC = coronary artery calcification | | CACS = coronary artery calcium score | | CAD = coronary artery disease | | CHD = coronary heart disease | | CI = confidence interval | | CTA = computed tomography angiography | | EBT = electron beam tomography | | HR = hazard ratio | | MDCT = multidetector-row computed tomography | | ROC = receiver-operator characteristic |
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